Human immunodeficiency (HIV) is a virus that attacks the immune system. This is the system that protects the human body from illness. The HIV virus destroys white blood cells called T-cells. These T-cells are what protects the body’s defense (immune) system. The HIV virus is spread through semen, blood, vaginal and anal fluids, and breastmilk.. The increasing migration of people and trade and transactions, whether through prostitution or greater economic opportunities, people from across borders are interacting with each other more than ever. These interactions are the leading cause of HIV.
(TB) is caused by mycobacterium tuberculosis. The bacterium can affect the brain, spine, lungs and kidneys. Mycobacterium tuberculosis is airborne and can be infectious. It is possible to carry the bacterium and not have the TB disease, which is called latent TB. However an individual with latent can develop the disease if their immune system is compromised and is weakened significantly. For example, HIV is the most powerful risk factor that can activate mycobacterium tuberculosis. The increase of HIV affects the control of TB diseases. Since HIV attacks the immune system, those with latent TB develop the TB disease.
Sub-Saharan Africa is incredibly affected by both HIV and TB. Sub-Saharan Africa has “almost two thirds of all incident and prevalent HIV infection and three quarters of all AIDS deaths.” Transmission of HIV in Sub-Saharan Africa is through heterosexual sex. 60% of HIV infections that occur in Sub-Saharan Africa occur to women, especially young women and girls. At the same time, for all new TB cases around the world, the Sub-Saharan region accounted for one third of the amount of new TB diseases. A quarter of those who were living with the TB disease also had the HIV infection.
The main obstacles to prevent these transmission of the infections and diseases is that there are difficulties of prevention at a larger scale. The Sub-Saharan region is a large region composed of eight countries, and thousands of different cultures and belief systems. Implementation at a larger scale is difficult to administer. There is a lack of communication and knowledge about sociocultural factors that can affect the efforts to minimize infection. Another issue is that 10-20% of people living with HIV in Sub-Saharan Africa know that they are infected. There is also less of a focus on prevention rather than on the subject of treatment. Because there are a large amount of people who need treatment and do not know that they have HIV nor TB disease, prevention is not addressed because that would pertain to those who are already are healthy.
There is a stigma about HIV in many places within the Sub-Saharan region. In places such as Ethiopia, there is a high perceived notion that antiretroviral therapy and HIV/AIDS treatment will have negative consequences, such as lack of anonymity within the community. They are less likely to trust physicians and tell them of their status. Community members are all frightened and concerned with the possibility that their community would shun them from the community. Ethiopia struggles to deliver basic health services due to a suffering economy. Though the Ethiopian citizens are reluctant to trust health programs, the Ethiopian Government is pushing to extend its services in the Health Sector Development Program. The program is a stydy that will study the prevalence of TB within HIV patients in Arba Minch. This study will look at the prevalence of pulmonary tuberculosis and associated factors among HIVpatients at the clinic.
Mother-to-child transmission rates for HIV-infected pregnant women in Sub-Saharan Africa vary widely depending on the access to and the type of antiretrotherapy (ART). Antiretrotherapies are distinguished by their effectiveness. Resource-rich countries and middle-income countries are able to access the triple-drug combination highly active antiretroviral therapy. Childhood TB is difficult to diagnose because the symptoms are not very specific and can be confused with the common cold. Because the on on-going HIV issue, TB is is more often sceened. However, there are only a few reports on the treatment and diagnosis of young Ethiopian children and coinfection of HIV and TB. It was found that HIV positive children were underweight and were six times more likely to die than HIV negative children. HIV posotive children are at risk of diagnostic error and delayed diagnosis of TB.
The College of Veterinary Medicine and Animal Sciences found that at the North Gondar Zone Hospitals, screened women for a smear test to see if they had tuberculosis and found that there was a high prevalence of smear-positive tuberculosis in pregnant women. The investigators suggest that there should be a screening program for pregnant women because they believe that pregnant women are they key to ending TB as prevalent diseases within Ethiopia. The investigators believe that there should be more research on pregnant women, so that their can be a collaboration with Ethiopian clinics, hospitals and other institutions to eradicate the TB disease from the country.
The investigators from Jimma University in Jimma, Ethopia concluded that Co-infected patients, nonliterate individuals, and females were more likely to have perceived stigma. These individuals are also the most at risk individuals. The investigators suggested for there to more education surrounding the topics of HIV and TB coinfection.
Ayesha Kharsany and Quarraisha Karim concluded that the most effective intervention would be condom usage. Their target population were MSM, PWID, and sex workers in Sub-Saharan Africa. For young girls, vaginal microbicides, PrEP and passive immunity was suggested. An issue that must be addressed in the future is the amount of people who do not know their HIV status.
The Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia decided that there should be TB screening for all HIV positive patients because most HIV patients do not know of their TB status.
For the World Health Organization, they addressed DOTS, MDR, and XDR diseases. Though they reached their target goals for their program, the prevalence of TB did not decrease. WHO implemented counseling, testing, mother to child transmission education, progressive treatment access, and stigmatizing HIV and TB within communities.
Based on the information that has been gathered, HIV and TB coinfection cannot be addressed until those who are infected know that they have the infection and/or disease. If they do not know that they have the disease they will keep on spreading the infection and disease and nor will they get treated. Based on the literature, the most helpful of the interventions were testing the individuals to confirm if they were infected with HIV or TB.
- Centers for Disease Control and Prevention: HIV/AIDS
- AIDS.gov: HIV/AIDS Basics
- Mayo Clinic: HIV/AIDS
- AVERT: What is HIV/AIDS?
- World Health Organization: HIV/AIDS
- Planned Parenthood: HIV/AIDS
- MedlinePlus: HIV/AIDS
- National Center for Biotechnology Information: Impact of Migration on the Spread of HIV and Tuberculosis in South Africa
- PubMed: Impact of Migration on the Spread of HIV and Tuberculosis in South Africa